Form Lst-1 - Local Services Tax - York County, Pennsylvania
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1YEAR
Local Services Tax
1
TOTAL NUMBER OF SELF EMPLOYED
1
TAX PERIOD
INDIVIDUALS AND EMPLOYEES REPORTED
HEREWITH
ACCOUNT
<<DISTRICT>>
NUMBER
2
GROSS AMOUNT OF TAX
YORK COUNTY,
2
(LINE 1 X TAX AMOUNT)
THRU
PA
FORM LST-1
3
NET AMOUNT DUE ENCLOSED
3
DUE ON OR
(LINE 2 MINUS LINE 3)
BEFORE
<<BUSINESS NAME>>
<<BUSINESS NAME>>
4
PENALTY
4
<<ADDRESS>>
<<ADDRESS>>
5
INTEREST (1/2% PER MONTH)
5
<<CITY>>, <<STATE>> <<ZIPCODE>>
6
REFUND
6
BUSINESS
FED
PHONE
EIN
7
TOTAL INCLUDING ANY PENALTY AND INTEREST
7
DUE
NAME OF CONTACT PERSON
RETURN THIS COPY TO THE TAX BUREAU
AUTHORIZED
SIGNATURE
REQUIRED
DATE
I DECLARE UNDER PENALTY OF LAW THAT THE INFORMATION CONTAINED HEREIN IS TRUE AND CORRECT.
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